Health and Adult Social Care Policy and Scrutiny Committee

26 April 2016

Report of the Programme Director, Older Persons‟ Accommodation

Update on the Older Persons’ Accommodation Programme

Summary

1. This report provides an update on progress towards delivering the Older Persons‟ Accommodation Programme. It also reviews the Moving Homes Safely protocol as it was applied to the closure of Grove House and Oakhaven care homes.

2. The following summarises the status of the Programme:

Overall Status On Target

Previous Project Status

On Target

Trend Same

Risks Under control

Update since last report

The Programme has progressed well, including: a) The implementation of 24/7 care at Glen Lodge. b) The safe closure of Grove House and Oakhaven. c) Successful public engagement on the plans to re-

develop the Burnholme school site as a Health & Wellbeing campus.

d) Award of a £850,500 grant to assist with the £4.1m cost of the 27 home extension of Glen Lodge.

e) Receipt of good tender prices for the construction of the Glen Lodge extension.

Programme next steps

To progress the Programme the team will: a) Seek Executive sanction to progress with the

development of the Burnholme Health & Wellbeing campus including procurement of a new care home.

b) Start on site with the construction of a 27 home extension to Glen Lodge.

c) Procure a partner to build an Extra Care scheme on the Oakhaven site.

d) Undertake design work to examine options for the Haxby Hall care home.

Background

3. The Health and Adult Social Care Policy and Scrutiny Committee last received an update on the Programme at their meeting in December 2015 and asked for regular updates. The Audit and Governance Committee also received an update on the Programme in February 2016, looking particularly at programme management. They, too, asked to receive six-monthly updates.

4. The Council‟s Executive on 30th July 2015 approved the Business Case for the Older Persons' Accommodation Programme. This will:

a) fund 24/7 care support at Auden House, Glen Lodge and Marjorie Waite Court Sheltered Housing with Extra Care schemes;

b) progress with plans to build a 27 home extension to Glen Lodge;

c) seek the building of a new Extra Care scheme in Acomb;

d) see the procurement of a new residential care facility as part of the wider Health and Wellbeing Campus at Burnholme; and

e) encourage the development of additional residential care capacity in York including block-purchase of beds to meet the Council‟s needs.

5. Sites affected by the Programme are shown on the map at Annex 1.

6. The context for the Programme is that there is a shortage in York of suitable accommodation with care for older people. This is caused by historic under-investment and expected growth in the size of the over 75 population of the city (the 75+ population is expected to increase by 50% over the next fifteen years, from 17,200 to 25,800). 81% of York‟s 75+ population own their own home.

Progress Update

Glen Lodge Extra Care

7. 24/7 care services have begun at Glen Lodge and, at the same time, recent vacancies have allowed people with higher care needs to move into the facility. Night-time care is now being provided to some residents.

8. Planning approval has been granted for the 27 home extension to Glen Lodge with the positive support from the Planning Committee.

9. On 10th March 2016 the Homes & Communities Agency (HCA) confirmed the award of a £850,500 grant to contribute towards the capital cost of building the 27 home extension to Glen Lodge. We applied for the grant in May 2015 and the award announcement was expected in October 2015. The Government Spending Review of 25th November 2015 announced that there will be a limit placed on Housing Benefit (HB) paid to social housing tenants taking up new tenancies by fixing it at private sector Local Housing Allowance (LHA) rates. The move is expected to have the largest impact on specially adapted properties which traditionally command higher rents including Extra Care. The government currently have no plans to exempt any particular property types or tenants of pension age. In response to growing and widespread concern from the housing and care sector about the future viability of such schemes the DWP said it is “working on the detailed design of the policy” and have delayed its implementation by one year, until April 2017. Should the policy apply to Glen Lodge it will have an impact upon low-income tenants‟ ability to pay. We have discussed options with the HCA and will make application for variation of the grant conditions to minimise the impact of the LHA at Glen Lodge.

10. Meanwhile, construction plans are on track. Building tenders are returned and are currently being evaluated. We expect start on site in either May or June 2016 and completion by Q2 2017, in line with Programme.

Oakhaven Extra Care facility

11. We are making progress with plans to develop an Extra Care facility on the Oakhaven site.

12. We have engaged in soft market testing with potential partners in the development of an Extra Care scheme on this site. They show good interest in the development and have provided guidance on how best to present the opportunity to market.

13. We will now proceed with the procurement of a partner to develop the Oakhaven site.

14. Meanwhile, we have “closed down” Oakhaven: shutting off water and gas so that all is safe (but leaving on the electricity so that the fire and security systems continue to operate) and moving out equipment for re-use elsewhere, if in reasonable condition, or for disposal.

The building will then stand empty while we procure a partner to re-develop it as an Extra Care facility. While it is empty we have offered its use as a temporary kitchen while Poppleton Road school kitchens are refurbished and for fire arms and dog training by North Yorkshire Police [no live ammunition].

Burnholme Health & Wellbeing Hub

15. The spatial plan for the re-development of the Burnholme school site has been completed and demonstrates that the site can accommodate all of the activities intended for the site. The plan is shown at Annex 2.

16. The public information events regarding the redevelop of Burnholme School have gone well. The team have shared information and gathered views on site at Burnholme, at St Aelred's school, at Osbaldwick Parish Council and via the Tang Hall Library and on-line. Current users have been particularly supportive of the plans. Local residents also welcome the mix of uses for the site but do express concern about the impact on traffic volumes.

17. We have also engaged with potential providers of the care home at Burnholme and they are positive about the opportunity and about the commercial arrangements which will give it life. However, they emphasise the need for the authority to show commitment and de-risk procurement for them by undertaking enabling work in advance of their appointment and demonstrating commitment to the whole-site re-development by obtaining planning consent for the community and library facilities (and by doing so demonstrate that the whole site has potential to be developed in accordance with the spatial plan).

18. Tees, Esk and Wear Valleys NHS Foundation Trust confirm their interest in moving onto the Burnholme site and working alongside the Priory Medical Group and other health providers to give life to a Community Health Hub for the east of the city.

19. We now prepare to take a report to Executive in May 2016 to secure consent to begin to deliver the Burnholme Health & Wellbeing Campus. Members will be asked to sanction the procurement of a partner to provide the care home on site, the preparation and submission of a planning application relating to the provision of community facilities and an access road and investment in enabling works to allow the home to be built. Members are also asked to sanction the sale of land for housing subject to Department of Education consent to release this land.

Haxby Hall

20. A designer has been appointed to assist with the development of options for the re-modelling or re-development of Haxby Hall.

21. Meanwhile, minor alternations to the building are being considered which will allow us to increase bedroom capacity from 49 to 53.

Programme Resourcing

22. The Programme budget for 2015/16 has been reviewed and has come in under budget for that year. The projection of future years‟ expenditure shows a potential for betterment across the whole Programme. However, more detailed evaluation is currently underway regarding use of capital receipts and this will determine the overall out-turn.

23. Programme resources continue to be actively managed:

a) We have secured the services of a University of York Biology PhD student under the Biology Research Council Doctoral Training Partnership to work with us for three months in the autumn of 2016. He will support the development of the Health Hub at Burnholme and is fully funded by the BBSRC.

b) We have sought interest from the University of York summer intern programme for a student to work with us on the Programme. Last summer the intern who joined us proved to be very helpful in moving forward developmental elements of the Programme. The programme management budget has provision for this cost.

c) We continue to keep under review the legal services support for the Programme and are considering using external legal support to help us procure the Burnholme care home.

Moving Homes Safely

Oakhaven and Grove House Older Persons‟ Homes

24. Oakhaven and Grove House care homes are now closed. All residents have moved to their news homes – a mixture of independent provision, Haxby Hall, Extra Care and out of area, as detailed below:

Oakhaven Grove House

Total %

Extra Care 1 1 2 6%

Haxby Hall 6 8 14 40%

Independent Sector

11 7 18 51%

Out of Area 1 0 1 3%

19 16 35

25. Grove House and Oakhaven staff have also moved to new roles. Of those that remained in the employment of the Council nine moved to Haxby Hall, four to Morrell House, five to Willow House, seven to Windsor House, 16 to Woolnough House and eight to the Extra Care service.

26. Grove House has been cleared and prepared for sale. We will market the sale opportunity shortly. As explained above, Oakhaven is to be held empty while we seek a partner to build an Extra Care facility on the site.

27. In accordance with the Moving Homes Safely protocol we have reviewed each move to check that all is well in the new accommodation. For the vast majority of residents the outcome of the move was positive, with comments including “loves” their new home, “family very happy” and, for one of the residents who moved to Extra Care, the comment that they “love their flat”. Some said that it had taken time to settle in their new home and two said that they missed their old home. A few of the new residents who had moved to Haxby Hall commented on staffing levels and this will be followed up.

28. Four residents expressed a neutral feeling about their move and while they are now settled in their new home:

a) One felt that the carers from their old home did not do enough on the day of the move to settle them into to the new accommodation; the need for very personalised support during the move will be re-emphasised as part of the update of the Moving Homes protocol.

b) Two residents said that they had taken time to settle in. It is important that we identify these individuals early so that personal support can be offered to help familiarise them with their new home and to support the settling-in process.

c) One said that they missed their old home.

29. Sadly, since moving and over the last two months, 3 of the residents who moved from Grove House and Oakhaven have subsequently died.

30. The team have also reviewed the overall operation of the Moving Homes Safely protocol as it was applied at Grove House and Oakhaven and have identified the following points which will be integrated into a refresh of the Protocol:

a) During the assessment period some families were angry at the decision to close these homes and also expressed dissatisfaction with communication during the consultation on closure. Some felt that they had to address their concerns through the complaints channel.

Action: Written briefings (in addition to the verbal briefings provided at Grove House and Oakhaven) will be made available at the start of any closure process with clear information on what will happen and when. These briefings will also offer answers to frequently asked questions. However, the emphasis on face to face contact, which proved to be useful and popular, will be retained.

b) Most residents and families were very pleased with the actual move day. Both Grove House and Oakhaven provided transport and carers to accompany them, and assistance with their belongings when required. Nearly all of the residents and families felt that they received a warm welcome by the receiving home. Some residents and families have stated that they prefer the new home as it meets the needs of their loved one more appropriately.

One family was not met by the receiving home and it caused distress to the resident and their family. One resident did not receive help from her current carer with unpacking and orientation, leading to dissatisfaction with the move.

Action: Re-emphasise the need for very personalised support on the day of the move including carers taking time to help residents to settle in, to un-pack and to familiarise themselves with the new accommodation. Follow-up visits in the days immediately after a move may be appropriate for some.

c) Most families reported that the receiving home has been very good and listened and acted on any concerns that were raised in the first few weeks. The receiving homes have also ensured that the resident has been transferred to the appropriate GP surgery and many have seen the GP as part of the placement agreement.

Action: Receiving homes should also take special care to help new residents orientate themselves and settle in, assisted by the relinquishing home where necessary. The care plan for each individual will identify specific needs and issues and guide the support that needs to be available.

d) At the review stage most residents have settled into their new placements. Many families reported that it took a few weeks to settle. Some residents have no memory of their last home.

Action: The need remains for the review visit within a four to six weeks of a move.

e) Some residents and families commented that Haxby Hall is large when compared to the home that they have moved from and that there is not enough communal space and quiet areas. Some also commented on staffing levels at Haxby Hall leading to a feeling that care was rushed and mistakes with laundry.

Action: Staffing levels and work practices at Haxby Hall have been reviewed, new staff moved over from Grove House and Oakhaven and work practices have been inspected by the Head of Service.

Designers will look at options for the re-modelling or re-development of Haxby Hall.

f) Clarity regarding funding arrangements for each resident as they move was identified as an issue requiring attention. Where the cost of care in the new home is greater than the current cost of care, funding for the difference will be the subject of the normal financial assessment process with consideration on a case-by-case basis dependant on financial and care needs. The move to nursing care also prompts a re-assessment of funding as this involved NHS funds. Where a resident is funded by another local authority via an out of area placement then they take responsibility for funding decisions. In all cases, clarity as to the decision making process is paramount.

Action: The Moving Home Safely protocol and guide will be updated to reflect clarity regarding funding, both for City of York Council clients and those supported by other local authorities.

31. The dedicated Care Manager who has overseen the move of residents from Grove House and Oakhaven will continue to oversee and annually review their care plans, ensuring consistency and helping to build upon knowledge of the individual. This Care Manager will also work to assess all the remaining residents of Council run care homes.

The future of the remaining council-run Older Persons’ Homes

32. The Programme also addresses the future of the five remaining older persons‟ homes that remain in the ownership of the council, as listed below:

OPH Address

Haxby Hall Station Road, Haxby, YO32 3DX

Morrell House 388 Burton Stone Lane, Clifton, YO30 6EZ

Willow House Long Close Lane, YO10 4UP

Windsor House 22 Ascot Way, Acomb, YO24 4QZ

Woolnough House 52 Woolnough Avenue, Tang Hall, YO10 3RE

33. These homes are no longer fit for purpose as they lack modern facilities (few bedrooms have ensuite bathrooms), small bedrooms limit care choices and the homes also have inadequate communal and social space. With the exception of Haxby Hall and because each home is small the option to refurbish or re-build is not possible. Therefore, each home will be the subject of consultation on closure over the next two years.

34. Meanwhile, homes are currently utilised as follows:

As at 21/03/16

Total Beds

Perm Beds

Respite Step

Up/Down Discharge to Assess

Capacity Occ Vac Occ Vac Occ Vac Occ Vac

Haxby Hall 41 37 4 0 0 0

Haxby Hall (Poppyfields)

8 8 0 0 0 0

Morrell House 29 25 3 0 1 0 0

Willow House 33 22 3 3 0 5 0 0

Windsor House 27 18 0 7 0 2 0 0

Woolnough House

33 22 1 1 0 4 1 4 0

TOTAL 171 132 11 11 0 12 1 4 0

35. Now that 24/7 Extra Care facilities are in place at Glen Lodge and Auden House (and will be in place at Marjorie Waite Court later in the year) we will begin to forge links between these facilities and nearly Council care homes, encouraging social and staff integration and, where relevant, the use of Step Down services in each care home to “feed” a vacancy at the relevant Extra Care facility. This will drive a more integrated service.

36. We will continue to work on the integration of “step-down, assess to discharge and respite” provision in the city, involving Council, CCG and health colleagues so that we can begin to formally align provision with need and drive towards a better flow of residents out of acute care and back to their own home. We have already begun this work and are currently utilising space at some of the Council care homes for these purposes, as listed above.

37. We will continue to develop the current Care Home staff team, including:

a) Working to raise staff skill levels to at least NVQ Level 2.

b) Rolling out person centred dementia care through Bradford University using a cascade model, by the end of April.

c) Internal rotation of day and night staff.

d) Implementation of one area of good practice per month and share this across the homes.

e) Use of „You said, We did‟ notice board in each home.

f) A volunteer programme to be launched in April, working in partnership with Yorkcares, including team challenges to encourage the homes to be part of the community.

38. We will launch a Tele-health pilot at Morrell for up to 10 residents to prevent avoidable hospital admissions.

Programme Plan

39. The Programme plan is proceeding well.

Tasks & Milestones Status

On Target

Previous Tasks & Milestones Status

On Target

Tasks & Milestones Status Explanation

A high level project plan is now in place and this will be reviewed and updated as the Programme proceeds. Detailed project plans are now in place for:

The Glen Lodge Extension The Burnholme Health & Wellbeing campus.

A draft project plan is in place for the new Extra Care facility in Acomb.

Key Milestones Date Milestone

Q2 2016 Executive to agree development timetable and procurement/s at Burnholme.

Q2 2016 Glen Lodge extension starts on site.

Q2 2016 Procure partner to deliver new Extra Care facility in Acomb.

Q2 2016 Submit Burnholme phase 1 planning application.

Q2&3 2016

Procure Burnholme care home.

Q3 2016 24/7 Extra Care starts at Marjorie Waite Court.

Q4 2016 Burnholme community/library works start on site.

Q4 2016 Submit New Extra Care facility planning application.

Q1 2017 Consideration of Burnholme care home planning application.

Q2 2017 Burnholme care home start on site.

Q3 2017 Burnholme community/sports/library accommodation complete.

Q2 2017 New Extra Care facility starts on site.

Q3 2017 Complete Glen Lodge extension.

Q2 2018 Complete New Extra Care facility.

Q4 2018 Complete Burnholme care home.

40. Risks

Risks Status On Target

Previous Risks Status

On Target

Key Risks

41. Key risks are kept under review and mitigations are pro-actively managed. No key risks currently present a concern.

00001 Anticipated level of capital receipts not realised

Date Added 14/04/2015

Description The existing sites may not realise the anticipated level of capital receipts included in the financial model.

Mitigating Action Work closely with partners and CYC finance to maximise capital receipts. Receipt from Oliver House was significantly above expectation.

00002 Lack of funding to deliver all of the elements of the project.

Date Added 14/04/2015

Description There is insufficient funding to deliver all of the elements of the project.

Mitigating Action Alternative sources of funding be identified and secured in order to achieve full project

00005 Increase in interest rates

Date Added 14/04/2015

Description Increase in interest rates would impact negatively on borrowing.

Mitigating Action Ensure impact is capped or controlled through the contracts.

00008 Project does not deliver the right number and type of care places required by the city

Date Added 14/04/2015

Description Project does not deliver the right number and type of care places required.

Mitigating Action Modelling of predicted care levels to look at effect of the provision of different numbers of care places by type.

00009 Loss of morale for existing EPH staff morale leading to negative impact on service provided to current EPH residents

Date Added 14/04/2015

Description Loss of EPH staff morale leading to negative impact on service provided to existing EPH residents.

Mitigating Action Maintain staff morale and focus through regular, open and honest briefings/updates; engagement through EPH Managers and staff groups; investment in staff training, support and development.

00011 Lack of appropriately trained staff to deliver quality of care required

Date Added 14/04/2015

Description Lack of appropriately trained staff to deliver the type and quality of care required i.e. Dementia and high dependency care.

Mitigating Action Develop an improvement plan based on best practice and identify service development programme.

00012 Burnholme - Disposal of redundant playing field not approved by Secretary of State

Date Added 09/07/2015

Description Approval not given for disposal of redundant playing field following objection(s) from local schools.

Mitigating Action Partnership working with local schools to ensure that requirements for playing fields are addressed via access to existing facilities.

00014 Burnholme - No long term commitment from NHS Provider Organisations

Date Added 09/07/2015

Description NHS Provider Organisations are not able to commit to long term lease due to relatively short term contracts (usually up to 5 years). Commissioning bodies therefore need to 'underwrite' by guaranteeing to mandate the premises within their tender/contracts.

Mitigating Action Early engagement with CCG as commissioning body. Engagement of a range of NHS partners.

00017 Burnholme - Planning Permission not granted / onerous

Date Added 09/07/2015

Description Inability to secure planning permission for development of suitable size for financial viability

Mitigating Action Early site master planning and pre-submission engagement

00018 Burnholme - Phasing & Construction Conflict

Date Added 09/07/2015

Description Need to procure elements of the Burnholme development through different commercial models leads to phasing and construction conflicts.

Mitigating Action Consider in deliberations regarding commercial options.

Recommendations

42. That the Committee review the update on progress to deliver the Older Persons‟ Accommodation Programme.

43. That the Committee request that regular updates are presented to future meetings.

Reason: So that Members are kept aware of progress towards delivery of the Older Persons‟ Accommodation Programme.

Contact Details

Author: Chief Officer responsible for the report:

Roy Wallington Programme Director, Older Persons‟ Accommodation Tel: 01904 552822 Email: roy.wallington@york.gov.uk

Martin Farran, Director of Adult Social Care Tel: 01904 554045

Report Approved

Date 14 Apr „16

Specialist Implications Officer(s) Legal – Ruth Barton (Ext 1724) Finance – Debbie Mitchell (Ext 4161) and Steve Tait (Ext 4065) Property – Philip Callow (Ext 3360) and Ian Asher (Ext 3379)

Wards Affected: List wards or tick box to indicate all All

For further information please contact the author of the report

Annexes: Annex 1- Plan of CYC Homes and Sites included in the OPAP Annex 2- Burnholme Spatial Plan

Annex 1: Plan: CYC Homes and Sites included in the OPAP

Annex 2: Burnholme Spatial Plan